Surgical therapy of thymic tumours with pleural involvement: an ESTS Thymic Working Group Project†

Abstract

OBJECTIVES: Surgery for thymic epithelial tumours (TETs) with pleural involvement is infrequently performed. Thus, the value of surgical therapy for primary or recurrent TETs with pleural involvement is not sufficiently defined yet. METHODS: Twelve institutions contributed retrospective data on 152 patients undergoing surgery (1977–2014) on behalf of the ESTS Thymic Working group. Outcome measures included overall (OS), cause-specific (CSS) and disease-free (DFS) survival as well as freedom from recurrence (FFR). RESULTS: In 70.4% of cases, pleural involvement was present at the time of primary intervention, whereas 29.6% had surgery for recurrent disease involving the pleura. Pleural involvement resulted from thymomas (88.8%) and thymic carcinomas (11.2%). Forty extrapleural pneumonectomies (EPPs), 23 total pleurectomies (TPs), and 88 local pleurectomies (LPs) were performed (completeness of resection in 76.8%). OS for the entire patient population at 1, 3, 5 and 10 years was 96.4%, 91.0%, 87.2% and 62.7%, respectively. There was no statistically significant difference regarding FFR and OS for patients with local or advanced disease undergoing EPP, TP or LP. Thymic carcinomas in comparison with thymomas had a negative impact on OS [hazard ratio 6.506, P = 0.002], CSS and FFR. Incomplete resections predicted worse OS [hazard ratio 6.696, P = 0.003]. CONCLUSIONS: Complete resection remains the mainstay of treatment for TETs with pleural involvement. Study populations treated with EPP, TP and LP had similar survival that may be factual as observed, but in the presence of selection bias, we can further conclude from the results that EPP, TP and LP are equally effective procedures. Procedural choice depends upon the extent of tumour distribution. EPPs, TPs and LPs performed within a multimodality setting seem to be efficient procedures for local control of disease, as they yield excellent results regarding OS, DFS, CSS and FFR.

<p>Optimal management of thymic malignancies: current perspectives</p>

“…53 Some authors advocate the place of debulking to improve the efficacy of high doses radiotherapy by minimizing fields and showed significantly better survival in stages III and IVa (p<0.05) 49 and others showed no benefits. 45,54 A multicentric analysis of the ESTS thymic working group 55 of 152 patients with pleural involvement highlighted the benefit of surgery (26% EPP, resection of pleural implants 58% and total pleurectomy 15%) on OS. Threeand five years OS were 91% and 87%, respectively, and 3 and 5 years PFS were 58% and 43%.…”

Surgical Cytoreduction and HITOC for Thymic Malignancies with Pleural Dissemination

“…[13][14][15]20 However, stage IVa patients who did not receive HITOC have published 5-year survival rates ranging between 53 and 87%. 5,6 The good overall-survival of surgically treated patients with thymoma stage IVa is an expression of the low metastatic potential of thymomas. One possible reason for this positive result may also lie in the high proportion of macroscopically completely resected tumors (86.2% in our study), since resection status is known to be an important prognostic factor.…”

“…Considering only patients with thymic malignancies (thymoma) in stage IVa, 5-year survival rates of 53 to 87% were reported after surgical resection. 5,6 A tumor of this extent is difficult to treat with surgical procedures because residual tumor cells often remain in the pleural cavity, leading to pleural recurrences. [7][8][9] Therefore, advanced stages require a multimodal treatment approach involving systemic chemotherapy, radiotherapy, or radio/ chemotherapy.…”

Follistatin impacts Tumor Angiogenesis and Outcome in Thymic Epithelial Tumors

“…Surgical tumor resection represents the mainstay of therapy even in case of recurrent disease or in TETs with pleural metastases 11 . Recurrences can occur even decades after radical tumor resection, and therefore life-long oncologic follow up is recommended 2,12,13 .…”